Intraperitoneal chemotherapy and cytoreductive surgery for peritoneal metastases coupled with curative treatment of colorectal liver metastases: an updated systematic review

Abstract

We aimed to assess the efficacy and safety of delivering intraperitoneal chemotherapy and cytoreductive surgery for peritoneal metastases coupled with curative treatment of colorectal liver metastases. Areas covered: A comprehensive literature search using PubMed was conducted to screen for eligible records. Studies evaluating colorectal surgery and intraperitoneal chemotherapy combined with curative treatment of liver metastases were included. We excluded duplicate publications. Sixty-seven full-text papers were assessed and six papers were finally included. The overall survival in the included studies ranged from 6-49 months. Five-year survival ranged from 18%-28%, three-year survival ranged from 22%-42% and two-year survival ranged from 34%-78%. Survival was lower in patients with liver metastases and peritoneal carcinomatosis (PC) than those with PC alone in the majority of studies. Expert commentary: This review poses questions rather than presenting answers. The heterogeneity of survival data suggests the possible benefit of this aggressive treatment approach in selected patients. Standardization of the technique used for intraperitoneal chemotherapy instillation, agent used as well as the systemic chemotherapy and targeted therapy type and duration through prospective controlled trials is required to provide an evidence of a higher strength to support or prohibit this treatment strategy.

Clinical outcomes of complete cytoreduction with concurrent liver resection followed by hyperthermic intraperitoneal chemotherapy for synchronous peritoneal and liver metastatic colorectal cancer

“…Since Elias et al published the first report about combined resection with intraperitoneal chemotherapy for patients with peritoneal and liver metastases, several surgeons have tried to attempt this challenging surgical treatment [17]. A recently published systematic review showed that combined curative resection with intraperitoneal chemotherapy for peritoneal and liver metastatic CRC resulted in a possible survival benefit in selected patients [18]. However, there have been only a few studies regarding this treatment, therefore the feasibility and the efficacy is still controversial.…”

Colorectal peritoneal metastases: Optimal management review

“…In the last decade, several publications have suggested the feasibility and shown the survival improvement of liver metastases resection without adding morbidity[50,51]. There is no consensus on the number of liver metastases that limits the indication for CRS plus HIPEC as long as complete resection can be fulfilled[52].…”

Patient selection for cytoreductive surgery and HIPEC for the treatment of peritoneal metastases from colorectal cancer

“…In these patients, a recently updated review of clinically heterogeneous studies revealed a median overall survival that ranged from 6 to 49 months, which was lower than in patients with isolated PM in most of the included studies 55. Additionally, a recent meta-analysis reported a significantly higher risk of death (hazard ratio 1.30) for patients with both liver metastases and PM treated with curative intent compared to patients with isolated PM 56.…”

“…However, a curative approach may be considered in highly selected PM patients with limited and resectable hepatic disease 55,56. Consequently, over the last decade, a substantial number of studies have reported on patients who were treated with CRS and HIPEC combined with local treatment of liver metastases.…”